Trying to engage in good faith: would you likewise say that the notion of sports medicine is irrelevant? That even though professional athletes have unique stresses on parts of their bodies that are not common in a general population, unique levels of societal pressure around accelerating their recovery time, and a need for rapid real-time diagnostics... a generalist physician would be as effective as a specialist?
Now imagine you're running a massive sports team, and you have a budget for medical care. But then a government entity comes and says: regardless of outcomes, you're not allowed to hire specialists or allow your team members to elect to go to specialists, because that could be seen as unfair... regardless of whether statistics point to improved outcomes if you were allowed to have certain specialists.
Looping back to suicide hotlines: even if the administration had increased funding to the hotline to compensate for the ended specialist program (which is highly unlikely, and that this was more likely a net funding loss) - it's a similar restriction on whether a lifeline program can allocate resources to specialists. And the stakes here couldn't be higher.
(And if statistics pointed to other groups benefiting similarly from specialization, I’d want a clinician-led organization to evaluate that research and determine budget allocation towards those specialists, too.)
> A national hotline that can handle anyone is clearly the right way
The data suggest otherwise [1].
Which makes sense. “For LGBTQ youth, risk factors such as bullying, abuse, negative family treatment, as well as negative emotions caused by anti-LGBTQ legislation have also been identified” [2]. If you’re in a community that’s tolerating all of that, your trust in generic institutions will be low.
> any more than Black or Asian or Indian cases
If a population is disproportionately committing suicide, they should be disproportionately resourced. “Native Americans and non-Hispanic White Americans” have “the highest suicide rate in the United States” [3].
The law that created the hotline even specifically mentions those two groups, along with rural Americans:
> (a) SENSE OF CONGRESS.—It is the sense of Congress that—
> (1) youth who are lesbian, gay, bisexual, transgender, or
queer (referred to in this section as ‘‘LGBTQ’’) are more than
4 times more likely to contemplate suicide than their peers,
with 1 in 5 LGBTQ youth and more than 1 in 3 transgender
youth reporting attempting suicide;
> (2) American Indian and Alaska Natives have the highest
rate of suicide of any racial or ethnic group in the United
States with a suicide rate over 3.5 times higher than the
racial or ethnic group with the lowest rate, with the suicide
rate increasing, since 1999, by 139 percent for American Indian
women and 71 percent for men;
> (3) between 2001 and 2015, the suicide death rate in rural
counties in the United States was 17.32 per 100,000 individuals,
which is significantly greater than the national average, and
the data shows that between that same time period, suicide
rates increased for all age groups across all counties in the
United States, with the highest rates and the greatest increases
being in more rural counties; and
> (4) the Substance Abuse and Mental Health Services
Administration must be equipped to provide specialized
resources to these and other high-risk populations.
Different people face different challenges, and helping them requires different strategies. You really don't think that there's anything unique about the challenges LGBTQ people face?
> There doesn't need to be a specialist for every group, or worse - some groups.
Why? The struggles different groups generally face are not the same. For a hotline for veterans, wouldn't it make sense to have counselors who are either veterans themselves or have worked extensively with veterans and their specific patterns of issues?
What is this assumption based on? It sounds political.
Are LGBTQ people at a higher risk for suicide? Could hotline staff reduce suicide attempts with special training? Seems like you could measure this.
Thinking about other groups with a higher risk--veterans, abuse survivors, gambling addicts--are there suicide prevention programs for these groups and are they effective?
There was actually a study done on this [0] that found LGBTQ youth are around four times as likely to attempt suicide compared to their non-LGBTQ peers.
> Thinking about other groups with a higher risk--veterans, abuse survivors, gambling addicts--are there suicide prevention programs for these groups and are they effective?
For veterans in the US, at least, there are specific programs targeting them since they do have a disproportionately high level of suicides and suicide attempts compared to the general population.
If a trans kid calls the suicide hotline and the volunteer suggests they stop wearing dresses to school so people won't bully them, I'm pretty sure the outcome will be far worse than anyone intended. There should be specialists who know how to handle specific kinds of callers.
By that logic, pediatricians and gynecologists shouldn't exist.
> A national hotline that can handle anyone is clearly the right way.
Absolutely. That describes this setup. You call the number. You get help. Sometimes that means a person trained in, say, talking to rape victims. (If you go to the ER, they'll have a nurse trained in it too!)
Per the article: "Also known as the 'Press 3 option,' the program gave 988 callers the option to 'press 3' to connect with a counselor trained to assist lesbian, gay, bisexual, transgender and queer youths and young adults (they could also text 988 with the word 'PRIDE'). Nearly 1.5 million contacts were routed to the LGBTQ service since its launch, according to data available on the SAMHSA website."
Those are physical differences. Which isn’t to say that you’re wrong, but we could easily have different things for physical differences and not for mental differences. Should we have different prisons for gays? Same logic, no?
The leading theories for the biological underpinnings of same-sex attraction are also physical—some combination of genes, prenatal environment, and biochemistry—so this argument fails both ways.
It’s moot in any case because the whole point is identifying groups of people who benefit from help tailored at their situation so it’d make sense to specialize even if it was a choice. If we saw tons football fans more likely to contemplate suicide after the Super Bowl we’d want to support them even though that’s unambiguously social. Helping people is what makes civilization worth having.
Good; we agree differences in a patient/customer may require special training/handling.
> Should we have different prisons for gays?
Again, this wasn't a different hotline. Just a phone tree option.
I suspect prisons, at times, have to manage things specific to gay inmates. Seems like it could cause roommate situations to be accounted for, as an example.
Trying to engage in good faith: would you likewise say that the notion of sports medicine is irrelevant? That even though professional athletes have unique stresses on parts of their bodies that are not common in a general population, unique levels of societal pressure around accelerating their recovery time, and a need for rapid real-time diagnostics... a generalist physician would be as effective as a specialist?
Now imagine you're running a massive sports team, and you have a budget for medical care. But then a government entity comes and says: regardless of outcomes, you're not allowed to hire specialists or allow your team members to elect to go to specialists, because that could be seen as unfair... regardless of whether statistics point to improved outcomes if you were allowed to have certain specialists.
Looping back to suicide hotlines: even if the administration had increased funding to the hotline to compensate for the ended specialist program (which is highly unlikely, and that this was more likely a net funding loss) - it's a similar restriction on whether a lifeline program can allocate resources to specialists. And the stakes here couldn't be higher.
(And if statistics pointed to other groups benefiting similarly from specialization, I’d want a clinician-led organization to evaluate that research and determine budget allocation towards those specialists, too.)
> A national hotline that can handle anyone is clearly the right way
The data suggest otherwise [1].
Which makes sense. “For LGBTQ youth, risk factors such as bullying, abuse, negative family treatment, as well as negative emotions caused by anti-LGBTQ legislation have also been identified” [2]. If you’re in a community that’s tolerating all of that, your trust in generic institutions will be low.
> any more than Black or Asian or Indian cases
If a population is disproportionately committing suicide, they should be disproportionately resourced. “Native Americans and non-Hispanic White Americans” have “the highest suicide rate in the United States” [3].
[1] https://pubmed.ncbi.nlm.nih.gov/30109965/
[2] https://en.wikipedia.org/wiki/Suicide_among_LGBTQ_people
[3] https://en.wikipedia.org/wiki/Suicide_in_the_United_States#S...
The law that created the hotline even specifically mentions those two groups, along with rural Americans:
> (a) SENSE OF CONGRESS.—It is the sense of Congress that—
> (1) youth who are lesbian, gay, bisexual, transgender, or queer (referred to in this section as ‘‘LGBTQ’’) are more than 4 times more likely to contemplate suicide than their peers, with 1 in 5 LGBTQ youth and more than 1 in 3 transgender youth reporting attempting suicide;
> (2) American Indian and Alaska Natives have the highest rate of suicide of any racial or ethnic group in the United States with a suicide rate over 3.5 times higher than the racial or ethnic group with the lowest rate, with the suicide rate increasing, since 1999, by 139 percent for American Indian women and 71 percent for men;
> (3) between 2001 and 2015, the suicide death rate in rural counties in the United States was 17.32 per 100,000 individuals, which is significantly greater than the national average, and the data shows that between that same time period, suicide rates increased for all age groups across all counties in the United States, with the highest rates and the greatest increases being in more rural counties; and
> (4) the Substance Abuse and Mental Health Services Administration must be equipped to provide specialized resources to these and other high-risk populations.
Full text of the law is at https://www.congress.gov/bill/116th-congress/senate-bill/266...
Different people face different challenges, and helping them requires different strategies. You really don't think that there's anything unique about the challenges LGBTQ people face?
> There doesn't need to be a specialist for every group, or worse - some groups.
Why? The struggles different groups generally face are not the same. For a hotline for veterans, wouldn't it make sense to have counselors who are either veterans themselves or have worked extensively with veterans and their specific patterns of issues?
What is this assumption based on? It sounds political.
Are LGBTQ people at a higher risk for suicide? Could hotline staff reduce suicide attempts with special training? Seems like you could measure this.
Thinking about other groups with a higher risk--veterans, abuse survivors, gambling addicts--are there suicide prevention programs for these groups and are they effective?
> Are LGBTQ people at a higher risk for suicide?
There was actually a study done on this [0] that found LGBTQ youth are around four times as likely to attempt suicide compared to their non-LGBTQ peers.
[0] https://www.cdc.gov/mmwr/volumes/69/su/su6901a3.htm
> Thinking about other groups with a higher risk--veterans, abuse survivors, gambling addicts--are there suicide prevention programs for these groups and are they effective?
For veterans in the US, at least, there are specific programs targeting them since they do have a disproportionately high level of suicides and suicide attempts compared to the general population.
If a trans kid calls the suicide hotline and the volunteer suggests they stop wearing dresses to school so people won't bully them, I'm pretty sure the outcome will be far worse than anyone intended. There should be specialists who know how to handle specific kinds of callers.
By that logic, pediatricians and gynecologists shouldn't exist.
> A national hotline that can handle anyone is clearly the right way.
Absolutely. That describes this setup. You call the number. You get help. Sometimes that means a person trained in, say, talking to rape victims. (If you go to the ER, they'll have a nurse trained in it too!)
Per the article: "Also known as the 'Press 3 option,' the program gave 988 callers the option to 'press 3' to connect with a counselor trained to assist lesbian, gay, bisexual, transgender and queer youths and young adults (they could also text 988 with the word 'PRIDE'). Nearly 1.5 million contacts were routed to the LGBTQ service since its launch, according to data available on the SAMHSA website."
Same hotline, just a phone tree option in it.
> pediatricians and gynecologists
Those are physical differences. Which isn’t to say that you’re wrong, but we could easily have different things for physical differences and not for mental differences. Should we have different prisons for gays? Same logic, no?
The leading theories for the biological underpinnings of same-sex attraction are also physical—some combination of genes, prenatal environment, and biochemistry—so this argument fails both ways.
It’s moot in any case because the whole point is identifying groups of people who benefit from help tailored at their situation so it’d make sense to specialize even if it was a choice. If we saw tons football fans more likely to contemplate suicide after the Super Bowl we’d want to support them even though that’s unambiguously social. Helping people is what makes civilization worth having.
You're right, maybe we should have the same counselors handling calls from 13 year olds girls and veterans, after all, what's the difference?
> Those are physical differences.
Good; we agree differences in a patient/customer may require special training/handling.
> Should we have different prisons for gays?
Again, this wasn't a different hotline. Just a phone tree option.
I suspect prisons, at times, have to manage things specific to gay inmates. Seems like it could cause roommate situations to be accounted for, as an example.
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Psychologists and therapists have different specialties too, for mental differences. This is generally considered a good thing.
[dead]
Specialization is useful in pretty much all human endeavors. It would be extremely strange if this was an exception.
Look, I get that you are approaching this in good faith, assuming that they cut these specialists because it was redundant and inefficient.
If this were 10 years ago, this would be an understandable assumption, but today there is absolutely zero reason to reach this conclusion.
The words of our own elected representatives make it very clear why these specialists were cut: because of hatred for the LGBTQ+ community.
That decision should be left to the people who study and understand psychology, not laymen, podcast hosts, and politicians.
Everyone is paying for these resources. It’s fair for everyone to understand why they’re worth it.
Is it? Does this same deal apply to, say, Area 51? Esoteric physics research? The details of mRNA vaccine production?
We have experts because we can't all possibly understand everything.
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